New Study finds common Sugar Alcohols (Xylitol) linked to Heart Disease - is it true?

Summary

The video script discusses recent studies linking sugar alcohols, specifically Xylitol and Erythritol, to cardiovascular disease. It explains the research methods, including metabolomic analysis and thrombosis assays, revealing a potential correlation between higher blood Xylitol levels and increased risk of cardiovascular events. However, the script also points out limitations in the studies, such as unaddressed confounding factors and the lack of long-term, randomized control trials. It concludes with a balanced view, suggesting that while there is cause for concern, more robust evidence is needed to establish a definitive causal relationship.

Takeaways

• 🔍 The media frequently reports on new studies linking sugar alcohols like Xylitol and Erythritol to cardiovascular disease, causing public concern.
• 🍬 Xylitol is a sugar substitute found in low-carb foods, processed foods, and dental products, and is also naturally produced by the body.
• 🧬 A study used an untargeted metabolomic approach to identify Xylitol metabolites associated with cardiovascular events and validated the findings with a targeted metabolomic technique.
• 📊 The validation cohort data showed a stepwise decrease in cardiovascular event-free survival with increased Xylitol levels in the blood.
• ⚠️ The study adjusted for potential confounding factors like age, sex, smoking, diabetes, blood pressure, and cholesterol, but some health differences among participants were not fully accounted for.
• 🐁 Animal experiments indicated that Xylitol could have a potent effect on thrombosis, the aggregation of blood platelets into a clot.
• 🧪 Human blood experiments showed that Xylitol increased the aggregation of platelets on a collagen chip, suggesting a potential impact on blood clotting.
• 📉 Short-term consumption of 30 grams of Xylitol led to a significant rise in blood Xylitol levels, but the long-term cardiovascular risk is still unclear.
• 🤔 The study has limitations, including not fully adjusting for all health differences among participants and the lack of long-term, randomized control trials on Xylitol's cardiovascular risk.
• 💊 The study's findings should be considered cautiously, as other studies have indicated potential cardiovascular benefits of Xylitol, such as improved endothelial function.
• 🚫 The current evidence does not conclusively prove that Xylitol causes cardiovascular disease, and more robust studies are needed to establish a clear cause and effect.

Q & A

What is the main topic of discussion in the script?

The main topic of discussion is whether sugar alcohols like Xylitol and Erythritol are linked to cardiovascular disease, as suggested by recent studies.

What is Xylitol and where is it commonly found?

Xylitol is a sugar substitute found in many low-carb, processed foods, some dental items, and is also naturally produced by the human body.

What is an 'untargeted metabolomic' and how was it used in the study?

An 'untargeted metabolomic' is a research technique that probes for many metabolites in the blood. In the study, it was used to associate these metabolites with cardiovascular events over a three-year follow-up period.

What is the purpose of the 'validation cohort' in the study?

The validation cohort is a second group of participants used to validate the results of the initial study with a technique called targeted metabolomics, providing greater sensitivity to identify Xylitol specifically.

How did the researchers measure the cardiovascular event-free survival in the study?

They measured the cardiovascular event-free survival by comparing the percentage of people who had not experienced any cardiovascular event over a three-year period, categorized by their blood Xylitol levels.

What does MACE stand for and what does it measure?

MACE stands for Major Adverse Cardiovascular Events and it measures the risk of cardiovascular disease events such as heart attacks, strokes, etc.

What experiment was conducted on mice to understand the effects of Xylitol on blood clotting?

A thrombosis assay was conducted on mice, where their blood vessels were injured to activate clotting and repair. The experiment compared the clotting times after injecting an inert substance or Xylitol.

What is the significance of the blood clotting experiment in the context of the study?

The blood clotting experiment showed that Xylitol can have a potent effect on thrombosis, indicating that it may increase the risk of pathological clotting that can stop blood flow in finer veins and arteries.

How did the researchers determine if normal day-to-day amounts of Xylitol affect blood Xylitol levels?

The researchers gave 30 grams of Xylitol to participants and measured their blood Xylitol levels over 24 hours to see if consuming this amount would significantly raise blood Xylitol levels.

What are some potential confounders in the study that the script mentions have not been fully addressed?

Some potential confounders not fully addressed include the overall health status of participants, previous cardiovascular disease, kidney health, and the use of certain medications, which could all influence cardiovascular disease risk.

What is the conclusion of the script regarding the consumption of Xylitol and its potential health risks?

The script concludes that while there are indications that Xylitol may increase cardiovascular disease risk, the evidence is not robust enough to warrant significant concern. It suggests that using Xylitol for dental purposes is likely not a major worry, and consuming it in normal quantities may not pose a significant risk based on the current studies.

Outlines

00:00

🧬 Controversy Over Xylitol and Cardiovascular Health

This paragraph delves into the recent media frenzy surrounding the potential link between sugar alcohols, specifically Xylitol and ariol, and cardiovascular diseases. The discussion is prompted by a study suggesting a correlation between xylitol consumption and an increased risk of heart attacks and strokes. Xylitol, a sugar substitute found in low-carb and processed foods, as well as in dental products, is scrutinized through an untargeted metabolomic analysis that identified its metabolites in the blood of individuals who suffered cardiovascular events. A validation cohort further confirmed these findings with a targeted metabolomics approach. The data presented shows a stepwise reduction in cardiovascular event-free survival with increased xylitol levels, indicating a potential risk that warrants further investigation.

05:02

🔍 Investigating Xylitol's Impact on Blood Clotting

The second paragraph expands on the initial findings by exploring xylitol's effects on blood clotting through both animal and human studies. In mice, xylitol was found to accelerate the clotting process, suggesting a potent effect on thrombosis. This was further supported by experiments using human blood, where xylitol exposure led to increased platelet aggregation on a collagen chip. The paragraph also discusses the potential implications of these findings, noting that while clotting is necessary for healing, pathological clotting can obstruct blood flow in veins and arteries. The speaker also humorously rates the physiological relevance of the findings, hinting at the complexity of interpreting these scientific results.

10:04

🤔 Weighing the Evidence on Xylitol and Cardiovascular Risks

The final paragraph critically examines the evidence linking xylitol to cardiovascular risks. It acknowledges the effort and methodology of the studies, including the use of reasonable doses to measure xylitol's impact on blood levels and the various aggregation assays. However, it also points out the limitations and potential confounders, such as the baseline health differences between study participants. The speaker emphasizes the need for more robust, long-term studies to establish a clear cause-and-effect relationship. They also mention a study using Mendelian randomization that found no association between xylitol and cardiovascular disease, adding another layer to the debate. The paragraph concludes by questioning the immediate need to abandon xylitol products, suggesting a balanced view on the current state of research.

Keywords

💡Sugar Alcohols

Sugar alcohols, also known as polyols, are carbohydrates that resemble sugar in sweetness but contain fewer calories and do not affect blood sugar levels as much as regular sugar. In the video, sugar alcohols like Xylitol and Erythritol are discussed in the context of their potential impact on cardiovascular health, with concerns raised by recent studies.

💡Xylitol

Xylitol is a sugar substitute and a type of sugar alcohol that is found in many low-carb and processed foods, as well as some dental products. The video discusses a study linking Xylitol to cardiovascular disease, exploring its effects on blood clotting and the potential risks associated with its consumption.

💡Cardiovascular Disease (CVD)

Cardiovascular disease refers to conditions affecting the heart and blood vessels, including heart attacks and strokes. The video's main theme revolves around the potential link between sugar alcohols, particularly Xylitol, and the increased risk of CVD, as suggested by recent research.

💡Metabolomic

Metabolomic refers to the comprehensive study of metabolites within a biological system. In the script, an 'untargeted metabolomic' is mentioned as a research technique used to identify many metabolites in the blood, which were then associated with cardiovascular events in a three-year follow-up study.

💡Validation Cohort

A validation cohort is a group of subjects used to confirm or validate the results obtained from an initial study group. In the video, a validation cohort is used to verify the findings from the initial 'Discovery cohort' regarding the association of Xylitol with cardiovascular events.

💡Thrombosis Assay

A thrombosis assay is a test used to study the clotting of blood. The video describes an experiment conducted on mice to observe the clotting process after injury to the blood vessels, with a focus on the effects of Xylitol on accelerating clot formation.

💡Platelet Aggregation

Platelet aggregation refers to the clumping together of platelets in the blood, which is a normal part of the clotting process to prevent bleeding but can also lead to harmful blood clots. The video discusses how Xylitol may increase platelet aggregation, as demonstrated through experiments on human blood.

💡Mandelian Randomization

Mendelian randomization is an epidemiological method that uses genetic variants as instruments to investigate the causal relationship between an exposure and an outcome. The video mentions a study using this method to explore the relationship between Xylitol and cardiovascular disease, concluding no association.

💡Endothelial Function

Endothelial function refers to the role of the endothelium, the inner lining of blood vessels, in various processes including blood clotting, inflammation, and vascular tone. The script mentions that other studies have indicated Xylitol might improve endothelial function, suggesting a more complex relationship with cardiovascular health.

💡Micromolar

Micromolar is a unit of concentration, indicating the presence of a substance at a level of one-millionth of a molar concentration. The video discusses the blood levels of Xylitol in micromolar amounts and how these levels relate to the risk of cardiovascular events.

💡Confounding Factors

Confounding factors are variables that can cause or appear to cause the relationship between two other variables, but are not the result of that relationship. The video points out that while the studies adjusted for some factors, there may be unaccounted confounding factors that could influence the relationship between Xylitol consumption and cardiovascular disease risk.

Highlights

Concerns raised about sugar alcohols like Xylitol and Erythritol potentially increasing cardiovascular disease risks.

Xylitol is a sugar substitute found in low carb foods, processed foods, and dental items, and is also naturally produced by the body.

A study links Xylitol to cardiovascular disease through an untargeted metabolomic analysis associating its metabolites with cardiovascular events.

A validation cohort was used to confirm the findings with a targeted metabolomics technique, identifying Xylitol specifically.

Data from the validation cohort shows a stepwise reduction in cardiovascular event-free survival with increased Xylitol levels.

Adjusted analysis still shows a significantly elevated risk in the group with the highest Xylitol levels, even after accounting for confounding factors.

Experiments in mice indicate that Xylitol can have a potent effect on thrombosis, the aggregation of blood into a clot.

Human blood experiments show increased platelet aggregation and clot formation when exposed to Xylitol.

Normal day-to-day consumption of Xylitol leads to a significant rise in blood Xylitol levels, which may be associated with increased cardiovascular risk.

A similar sugar alcohol, Erythritol, also shows effects on cardiovascular health in a separate study.

Despite the findings, there are concerns about the studies not adjusting for all potential confounders, such as overall health status.

The studies provide a patchwork of evidence, but do not conclusively prove a direct cause and effect relationship between Xylitol and cardiovascular disease.

A Mendelian randomization trial suggests no relationship between Xylitol and cardiovascular disease, offering a different perspective on the risk.

The long-term effects and safety of Xylitol consumption are still not fully understood due to a lack of prospective studies and long-term randomized control trials.

For dental use, the risk associated with Xylitol is likely minimal, but caution is advised for ingestion.

The study's findings should be considered alongside other research indicating potential benefits of Xylitol for cardiovascular function.

The presenter encourages viewers to remain open to future studies that may provide a clearer understanding of Xylitol's impact on health.

A call to action for viewers to consider their Xylitol consumption and whether they should continue using it based on the current evidence.

Transcripts

doesn't it seem like every few weeks

there's a new study that the media

landscape is up in arms about maybe my

ear is too close to the ground

considering well it's my field still it

seems constant we are here to discuss if

sugar alcohols like Xylitol and ariol

are going to stop your heart and send

you to an early life retirement and it's

all due to this study xylitol is a sugar

substitute that's found in many low carb

foods processed foods and even some

dental items however your body also

produces it as I mentioned Xylitol has

now been linked to cardiovascular

disease and we'll see if that's true or

not but I'd like to in Consulting speak

Loop in another study that shows the

same results but for ariol here so now

we have two studies indicating the same

scary situation should we run for the

hills last time I made that reference in

editing we accidentally added uh the

iron made song The Trooper instead of

Run to the Hills and got called out by

my fellow metalheads so allow me to

correct that here should we Run to the

Hills oh yeah I absolve myself of my

metal sins okay back to the study the

researchers of this study took data from

two different groups of people one group

called The Discovery cohort had blood

sampled and then the researchers

performed a research technique called an

untargeted metabolomic essentially they

probed for many metabolites in the blood

and then Associated that to a three-year

followup of these people to see who had

cardiovascular events like heart attacks

Strokes

Etc the idea being that if one

metabolite is much higher in people who

suffer from a CBD event that's

cardiovascular event then they can focus

on that metabolite they ended up

discovering that Xylitol like molecules

metabolites Associated well with CBD

events but because this was untargeted

they needed greater sensitivity to

separate out Xylitol specifically that's

where the validation cohort comes in the

second group to validate the results

with a technique called targeted

metabolis mix see how that works now

they had the sensitivity to identify

Xylitol specifically but don't take my

word for it I'm just a dude on the

interwebs let's look at the data here

I'm showing you the validation cohort

data on the left we see a graph with the

event free survival meaning that the

percentage of people who have not

experienced any cardiovascular event

remember that's heart attack stroke Etc

the higher the line the better the

outcomes so you don't want the lines to

go down the horizontal axis is the

number of years of followup that's a

three years total so we're comparing the

T1 with those with the lowest

concentration of blood Xylitol to T2

those with a moderate amount and T3

those with the greatest amount of

Xylitol You Now understand the worry

don't you it looks like a stepwise

reduced cardiovascular event survival

with increased in Xylitol levels this

was further Illustrated in the graph on

the right with the dotted line one being

the risk of the T1 group and the dots

and lines representing the elevated risk

relative to T1 if they move to the right

there's increased mace risk which is a

measure of cardiovascular disease events

the unique aspect here is that the red

dots and lines are an adjusted analysis

so the researchers are removing

potential confounding factors that might

explain the increased risk such as age

sex smoking diabetes uh blood pressure

cholesterol containing lipoproteins

triglycerides and an inflammation marker

C reactive protein as you can see the T3

condition still shows significantly

elevated risk are you slowly removing

that Xylitol filled gum from your mouth

yet well

that's not all the data another

experiment they did was in mice because

this experiment would be illegal to do

in humans they performed a thrombosis

assay which means that they injured the

blood vessels of mice to activate them

to clot and repair the injury however

they did this after injecting an inert

substance that's the vehicle seen here

or injected xylol if you want to look at

the micrographs the more white that

there is the more clotting happen

happened as you can see both conditions

clotted which is a good thing but look

at the times that it took to clot the

Xylitol exposed condition clotted much

faster this is also shown in the graph

on the right the red Xylitol condition

is lower indicating less time elaps to

clot now by itself that's not a bad

thing we need to clot but it's simply

shows that Xylitol can have a potent

effect on thrombosis the aggregation of

LS into a clot if it is pathological it

can completely stop blood flow in finer

veins and arteries I don't know about

you but I enjoy my blood flow although

it sometimes fails to reach the humor

side of my

brain I actually didn't think that was

too bad I think it fit pretty nicely

still physiological and still related so

I'll give that

one eight out of 10 got good blood flow

today next they repeated this experiment

in humans whole blood remember it would

be illegal to cause damage to someone's

arteries and watch it get clogged up

after injecting them with Xylitol so the

next best thing is to remove blood

expose it to a microchip with collagen

on it and then expose Xylitol and the

vehicle that's the inert substance

remember independently to the blood and

collagen then the more green that you

see means that there's more platelets

that bound to the collagen chip

indicating greater aggregation of

platelets we can see a quantification on

the right side over 3 minutes time I

probably don't need to spell it out for

you I'm assuming the XY all exposed

human blood aggregated onto the collagen

much more than the vehicle which is the

correct comparison they did many

experiments using different uh other

activating molecules but I'd like to

focus on the highlights the paper

reference is linked for you if you'd

like to Deep dive into it for yourself

now we know that people with more blood

Xylitol correlate with increased cvd

risk we know that Xylitol increases

aggregation of platelets and cloth

formation next we should probably find

out if consuming normal day-to-day

amounts of Xylitol will even budge our

blood Xylitol levels it's estimated that

Xylitol consumers eat or drink on

average around 30 gram of Xylitol so so

the researchers gave 30 G of Xylitol to

people and measured their blood values

over 24 hours each line represents a

single person the vertical axis is the

amount of blood Xylitol and the

horizontal axis is the 24 hours of

measurement you can see the blood

Xylitol levels start below one

micromolar and the peak is around I

don't know what like 7 800 micromolar

something like that now for reference

the amount found to be associated with

increased cvd events was a measly 30

micromolar and even less than that the

researchers have drawn a dotted line for

the 30 micromolar cut off so these

people had above believe dangerous

levels for about 30 to 60 Minutes

however keep in mind that the risk was

also seen at values as low as a few

micromolar meaning these people were in

the at risk concentration for at least 6

hours and probably longer after 13 G

consumption of Xylitol you also notice

that three people had their lines go up

and they didn't have the lines go

further into measurement that's because

they suffered massive coronary heart

attacks and died I'm kidding it was just

measurement error and inability for them

to be remeasured so they removed their

data

points could you imagine okay I won't go

through all the data again but there is

an ariol study a similar sugar alcohol

to Xylitol that also shows these same

effects just as a quick glance does this

look familiar the Q4 is the highest

blood ryol

levels okay enough doomsday by now

you've spit out your sugar-free gum and

thrown the whole pack in the trash well

you may want to pull it back out or not

we'll

see obviously these studies took a lot

of work and I do like aspects of them

like the fact that they used a

reasonable dose to indicate the overall

burden of Xylitol on blood at Xylitol

levels or some of these aggregation

assays many of which I didn't show you

for time sake I also like the fact that

they didn't adjust at analysis on the

association because it strengthens the

argument that all said there are some

undercover problems that haven't been

addressed for example if we pop open the

validation cohort data again the T3

condition there is yes high in Xylitol

and yes it's adjusted for many factors

but if you open the Baseline data on

these participants in both the Xylitol

study and the ariol study they also have

higher rates of previous cardiovascular

disease they take more drugs for their

health and they have worse Kidney Health

among other differences so while the

researchers adjusted for some factors

they didn't adjust for all of them plus

even if they had it seems clear to me

that the T3 and even the t2 group were

in worse overall health which is not

something that you can just adjust for

statistically for example if you remove

all the diabetic individuals that still

doesn't account for the people that have

had previous heart problems and may be

pre-diabetic the overall background of

these people their overall health is

different which is a huge contributor to

their risk of cardiovascular disease

it's an entirely different story when

you have two groups of people that are

the same Health at the beginning except

they differ in one factor because then

you can adjust for that factor that

isn't the case here additionally we're

looking at Xylitol blood levels but

we're not talking about consuming

Xylitol yes there were some short-term

experiments but all these data culminate

in a patchwork of evidence that on

assumptions that they tie into one

another for example I understand it's

worrisome to see data indicating Xylitol

increases clotting when activated to

clot and that's important it doesn't

just cause clotting on its own but other

Studies have also indicated that Xylitol

improves other mechanisms of

cardiovascular function like endothelial

function as a matter of fact that study

that I just referenced is a mandelian

randomization trial which means that it

looks at Xylitol related genes and tries

to find associations between these genes

and disease risk it's a honestly it's a

pretty lackluster explanation but time

is money and money is time or I don't

know something like that the point is

it's another way of assessing xylol risk

and they concluded there was no

relationship between Xylitol and

cardiovascular disease I have some small

issues with this study too though so

it's not perfect and I don't think that

it absolves Xylitol

entirely

unfortunately we don't have any

prospective studies on Xylitol or

long-term randomized control trials

looking at its cardiovascular risk and

just because I brought up some

confounders to this analysis does not

mean that xylol couldn't be the culprit

however since we only have a handful

studies it's impossible to get a clear

idea that said using it for dental and

not ingesting it is probably not a big

worry and I understand that consumption

is also a common use and it's true that

30 G did lead to a significant rise but

again the long-term data was in blood

levels not consuming xylol additionally

all the aggregation assets indicating

Xylitol increases blood clotting were

done at a concentration of 30 micr Moler

but let me clue you in on one more piece

of data here this is another aggregation

assay with the higher levels on the

vertical axis indicating greater

thrombosis but I want you to pay

attention to the horizontal axis notice

that the effect is only statistically

significant at 30 100 and 300 and notice

the effect size at

300 which is 10 times what people are

exposed to in blood for 60 minutes only

increased aggregation by 2.46 fold and

consider that generally your Xylitol

levels will be well below 10 micromolar

which according to this assay shows no

effect so am I worried based on this and

the orthol study alone no I'm not

however I am open to Future studies that

actually show a more robust cause and

effect so my question for you is did you

take your Xylitol gum out of the trash

or not anyway allow me to freak you out

in this next video right here I'll speak

with you over there

[Music]